6.1
This chapter examines issues associated with training and qualifications for the workforce supporting the National Disability Insurance Scheme (NDIS), noting that a skilled and qualified workforce is essential to the delivery of quality supports. It also makes some preliminary recommendations to enhance and—as appropriate—harmonise training and qualifications.
6.2
Key issues considered in this chapter include:
the required training, skills and attributes of the disability workforce;
the adequacy of existing training programs, including university and Vocational Education and Training (VET) courses;
the transition from education to employment—including placements, graduate opportunities and early-career mentoring; and
national registration and accreditation for disability support workers.
Required training, skills and attributes
6.3
Submitters and witnesses gave examples of the skills and expertise that are required to deliver quality, safe supports to people with disability. Consensus was that the NDIS workforce requires a strong foundation of core skills in communication, rights and ethics, and the social model of disability. Building on this foundation, workers must be equipped with 'generic' technical skills to support people with disability, and specific skills to support certain cohorts.
6.4
The committee heard that a crucial aspect of disability support is general 'awareness' of disability. For example, Mr Ross Joyce, Chief Executive Officer (CEO), Australian Federation of Disability Organisations (AFDO), stated that:
[I]t's about people just having, first-off, that awareness of disability, and also engaging with a person with disability without the first instance of that happening when they actually walk in the door to provide support to a person with disability. I think that's going to be the one that will start to break down a lot of barriers and misconceptions—and also unlock some personal bias.
6.5
Lack of awareness about disability and its impacts may also result in adverse consequences for participants—as support workers may lack even a basic understanding of how a person's disability affects their daily life, and may make unfounded assumptions about capability. Ms Tammy Milne, an NDIS participant, stated that:
Training; don't mop the floor around the disabled person…and leave them in an island of water.
…[The support worker] suggested I get support tomorrow instead. I said
I had to go to work…Her response surely I couldn't go to work if I was in so much pain. Subtext: because people with disabilities don't have jobs that require professionalism and at times an attitude of pushing through; its just one day.
6.6
Evidence before the committee also highlighted the importance of rights-based training. For example, Dr John Chesterman, Deputy Public Advocate, Office of the Public Advocate (Victoria) (Vic OPA), stated that:
[H]uman rights training needs to be front and centre. This is the best way to prevent violence, abuse, neglect and exploitation, by basically getting people who will be working in the scheme to imagine what it would be like to be a recipient of a service. That can be crafted. There are some good training packages that exist, and we would like to see national consistency on that topic.
6.7
The committee also heard evidence regarding the importance of ensuring the workforce understands the social model of disability. Ms Mary Sayers, CEO, Children and Young People with Disability (CYDA), expressed concern that the focus of the NDIS has moved to the medical model of disability and practices that aim to 'fix' children and young people with disability. Ms Sayers observed that much of this is driven by a lack of workforce knowledge on the social model, as well as by the funding model underpinning the NDIS—where there are vested interests in delivering individual therapies in lieu of building participants' capacity.
The attributes required for disability support work
6.8
Some submitters observed that the NDIS workforce must possess particular attributes to deliver quality supports and services. Many of these are related to the core competencies noted above—including an understanding of rights and ethics, and an appreciation of the nature of disability and its manifestations.
6.9
Catholic Social Services Australia (CSSA) observed that disability support work requires empathy, compassion, and commitment to improving the lives of others. Ms Tammy Milne similarly stated that a support worker must:
…understand the importance of the work where others may judge it as menial and beneath them…[T]hey know what they are doing is making a huge difference in the lives of the people they work with. Pride in your job and knowing you are making a difference in someone's life, enabling them to live with dignity is worth so much more. It's the food for the soul.
6.10
Purpose at Work (PaW) observed that the 'relational' nature of support work can make it difficult to clearly articulate the attributes support workers must possess. As an example, PaW noted that one study found that:
people with disability value support workers who listen; are friendly, kind and happy; and are familiar to the person;
family members and guardians value communication, honesty, trust, loyalty and kindness; dedication to the work; and a drive to perform the work for the 'right' reasons; and
support workers value colleagues and who listen; are trustworthy, loyal and honest; are dedicated; are team players; and who are performing the work for the 'right reasons'.
6.11
The committee also heard that while personal attitudes are important to the delivery of quality services and supports, they are not sufficient. They must be supported by skills and training. For example, Mr Lloyd Williams, National Secretary, Health Services Union (HSU), stated that:
The committee may have heard evidence that attitudes and values are more important than skills and training. Our concern is that that's a false debate. NDIS workers need to have the right values and attitudes, but they also need to have the right skills and training to ensure that they can deliver the supports that an NDIS participant needs and that those supports are high quality and safe. This is particularly important for those participants who have complex health and behavioural needs.
Specific skills and competencies
6.12
In addition to highlighting the core skills required by the disability workforce, submitters and witnesses emphasised that the workforce must be equipped with the additional skills and expertise needed to effectively support particular cohorts of participants—who will have needs specific to their disability. For example, Professor Christine Bigby stated that:
If you think about somebody with a severe and profound intellectual disability, the critical base of skills and knowledge that you, as a support worker, would need to work with that person would be very, very different from working with somebody who has a physical or sensory disability but no cognitive impairment and so would be very well able to direct you and tell you exactly what they want you to do and how they want you to do it, and to admonish you if you don't do it in the way that they would prefer. So I would argue that we have an underlying base of core skills and knowledge for particular groups of people, and then on top of that you would have additional skills for a particular individual.
6.13
Submitters representing specific cohorts of people with disability echoed these views. For example, Multiple Sclerosis (MS) Australia noted that it is critical that the workforce to understand chronic, progressive, degenerative conditions such as MS, stating that specialist providers should be enabled to provide knowledgeable support to people with specific needs throughout their plan development and implementation. Deafblind Australia stated that the workforce is not equipped to support participants with deafblindness. Further, mainstream providers are typically unaware of the competencies required by communication guides, and do not pursue training or recruitment strategies to address skills and knowledge gaps.
6.14
The committee also heard evidence regarding the unique skills needed to work in particular models of support. At a public hearing, Mr Harry Lovelock, Director, Policy and Research, Mental Health Australia (MHA), addressed the skills needed to support people with psychosocial disability in a recovery-oriented framework:
Recovery oriented care is accepted best practice in psychosocial support services. This means psychosocial disability workers need to be highly skilled in developing connection and capacity building as they support people to pursue what they find meaningful in life. Unfortunately, many service providers are finding it difficult to recruit and retain [an] adequately skilled psychological workforce under the NDIS.
6.15
In a joint submission, MHA, Community Mental Health Australia (CMHA) and Mental Illness Fellowship of Australia (MIFA) noted that some of the skills needed to support participants with psychosocial disability include:
forming strong working alliances with participants;
working effectively with the family and carers of participants;
acknowledging and addressing participants' fears and barriers;
providing effective social skills training; and
understanding and appropriately responding to the impact of trauma, social determinants, and the episodic nature of many mental health issues.
6.16
The committee also heard that the workforce must understand participants' needs outside of (but often intersecting with) their disability. For example, representatives of CYDA expressed concern that the basic needs of children and younger participants may be neglected where too great a focus is placed on their impairment, stating that:
[C]hildren and young people with disability are children first of all and have the same core needs as other children and young people. These core needs are good health care, adequate nutrition, security and safety, responsive care giving, opportunities for early childhood learning, a range of experiences across environments and opportunities for meaningful participation in the home and community activities.
6.17
The Disability Council NSW stated that aged care training is needed to support people with disability who are ageing, noting this is increasingly relevant with an ageing population.
Active support
6.18
Professor Christine Bigby emphasised the importance of Active Support for people with intellectual disability, noting there is 'overwhelming evidence' that Active Support leads to improved outcomes for this cohort. Professor Bigby gave an illustrative example during one of the committee's hearings:
Basically, active support is a way of working with people where, for example, you might be a support worker and it's tea time. You would go into the kitchen, as a support worker, and you would leave the person that you're supporting outside the kitchen. You could draw up a stool for them and let them watch you while you cook tea. Or you could say to the person, 'What are we going to cook together today?' and you would support that person no matter their disability to participate in every step along the way of making dinner. It would depend on the level of their disability but you would suggest to them, 'Do you want to get the ingredients and get this and this out of the fridge?' and give the person the cues or the directions that they might need to fulfil that successfully.
6.19
Professor Bigby noted that there is strong evidence that staff require training in Active Support delivered by an experienced practitioner, and expressed concern that the practice has been difficult to embed within organisations.
Cultural competency
6.20
Submitters and witnesses emphasised that the workforce must be equipped to deliver culturally appropriate services, particularly to Aboriginal and Torres Strait Islander participants and participants from culturally and linguistically diverse (CALD) backgrounds. Evidence also highlighted the needs of other participants who may experience intersectional disadvantage such as members of the LGBTIAQ+ community. For example, in the context of supporting people with psychosocial disability, MHA, CMHA and MIFA stated that:
We need to develop a psychosocial disability workforce able to respond to the diversity of the Australian population. NDIA data shows that people from culturally and linguistically diverse (CALD) backgrounds make up 8.4% (24,023) of participants in the Scheme, and are more likely to have a psychosocial disability as a primary disability than non-CALD participants (11% compared to 9%).
Aboriginal and Torres Strait Islander peoples have particular needs for culturally responsive services, with disproportionate experiences of mental health needs associated with the impacts of colonisation and complex social determinants of health.
People who identify as LGBTIQ+ also experience mental health issues at a disproportionate rate, and benefit from services that are culturally sensitive and aware to the particular experiences and needs of the LGBTIQ+ community.
Abuse detection and response
6.21
The Vic OPA observed that the establishment of an anti-abuse culture within the disability sector requires strong leadership and continuous professional development. It stated that Community Visitors recommend that all disability workers and providers should be required to complete abuse detection and response training, to build a more sophisticated understanding of actions that put people with disability at risk of abuse, neglect and exploitation.
The adequacy of existing education and training programs
6.22
The committee heard that there are concerns around whether university and VET programs are sufficient to equip the workforce with the necessary skills to deliver quality supports and services to people with disability. Where VET and university programs do not equip a person with the necessary skills to work in the NDIS, individual providers may be obliged to provide training as a means of addressing gaps in their employees' skills—often at substantial cost.
Vocational education and training
6.23
Ms Mary Sayers, CEO, CYDA noted that current Certificate III programs do not have a holistic focus on the needs of children and young people with disability. Ms Sayers also asserted that the focus should not be on which specific qualification the workforce should hold as a minimum, but on embedding training on supporting children and young people with disability in all existing programs.
6.24
Mr Tim Wilson, Executive Manager, Workforce Development, Cara, stated that certificate-level programs may not equip workers with the necessary skills to deliver supports in Supported Independent Living (SIL) or short-term accommodation settings, stating that:
[O]ur baseline is that they have to be able to have their manual handling, they have to have infection control and they need to have medication administration, because that is largely what we do. A number of those things are covered either inadequately or not at all in the Cert III level, largely. We've had to partner with a Cert III provider so that we can be assured that the standard that they provide with infection control is actually what we would want.
6.25
Mr Wilson observed that there would be value in embedding orientation programs for support workers within Certificate III qualifications (noting that this is typically the 'baseline' level of training for disability work). In addition, Mr Wilson suggested that there would be merit in increased focus on behaviour support, given increased demand for workers to support participants with autism spectrum disorder and related disability types.
6.26
Professor Christine Bigby noted that there is a sense that VET curricula are 'full of a very general type of content', and are not evidence-based or well taught. Professor Bigby stated that although there has been 'conversation' around the curricula being redeveloped, it is not clear if reforms have been progressed.
University education
6.27
The committee heard that some university-level courses do not equip graduates with all the required skills to support people with disability. In particular, the committee heard that allied health programs lack specific focus on disability, or focus too heavily on clinical interventions without teaching more general skills related to disability support.
6.28
Ms Claire Hewat, CEO, Allied Health Professions Australia (AHPA), noted that allied health professionals often complete qualifications before selecting a career path (for example in health, disability or aged care), and observed that the relevant courses are often quite generalist. Ms Hewat also stated that the nature of allied health courses makes it difficult to redesign the courses to focus on a specific matter:
Because the courses are so broad, it is very difficult to say: 'Okay, we're going to put more disability in.' What do you take out? Are you going to put more aged care in? Then what do you take out? There's only so much you can do in undergraduate training for a generalist profession.
6.29
Exercise and Sports Science Australia (ESSA) noted that while tertiary courses may educate health professionals on the nature of and interventions for specific disability types, they rarely equip professionals with the skills needed to overcome communication barriers or understand rights and responsibilities. It asserted that training programs should be used to upskill allied health professionals to address these skills gaps.
6.30
The Australian Physiotherapy Association (APA) recommended that the NDIA collaborate with the tertiary education sector to embed modules related to disability in physiotherapy degrees. Professor Christine Bigby similarly asserted that disability should be a mandatory component of all allied health courses.
6.31
A lack of specialised training for particular allied health professions was also highlighted. Vision Australia observed that equipment- and function-specific training such as Braille is either left to the individual to obtain, or treated as a development gap to be addressed by the service provider post-recruitment.
Encouraging participation in higher education
6.32
Notwithstanding potential issues associated with current university and VET curricula, the committee heard that efforts should be made to encourage people to take up programs of study which feed into the NDIS, in order to ensure that there is a sustainable pipeline of qualified workers in the sector. However, education costs can be high, and may not be attainable for some prospective entrants.
6.33
The Northern Territory Office of the Public Guardian (NT OPG) stated that initiatives should be offered to encourage individuals to obtain qualifications specific to the disability sector—including VET qualifications such as Certificate III in Individual Support, Certificate IV in Disability, or higher education qualifications in allied health. It observed that these initiatives may include fees and HECS exemptions, paid study leave and direct funding to the sector to provide relevant training.
6.34
The committee heard that there are some initiatives in place or being trialled to encourage uptake of tertiary programs. For example, representatives of CYDA noted that when free TAFE was offered in aged care and disability in Victoria, community services 'went through the roof'. The WA Government noted that WA has invested $53.5.million to reduce the cost of TAFE fees by 50 per cent for courses that include Certificate II in Introduction to Disability Care and Certificate IV in Disability.
Education and training in regional, rural and remote areas
6.35
Submitters and witnesses indicated that the tertiary education and training sector must respond to workforce needs in rural, regional and remote areas. This includes ensuring the tertiary curriculum reflects rural health concerns, and there are quality placements for students in rural and remote areas. The committee also heard that the education sector is not responding to this need. For example, Ms Claire Hewat, CEO, AHPA, observed that:
There is a lack of programs directly targeting workforce maldistribution, including lack of allied health university courses in some parts of Australia with significant shortages, such as Tasmania.
…To the best of my knowledge there is a pharmacy course and a psychology course…[but] that's it. There's no dietetics, there's no podiatry, there's no physiotherapy. Those kinds of courses are not offered in Tasmania at all. If you want to train, you have to leave the state.
6.36
The Tasmanian Government raised similar concerns, noting that it is working with the University of Tasmania on an allied health expansion project, with additional study programs to commence in 2022. The Tasmanian Government expects that this project will have a positive impact on the supply of allied health professionals in Tasmania; however, there will still be a four to five-year lead time until the supply of professionals is increased.
6.37
AHPA argued that urgent policy change is needed to ensure that the education system responds to current and future workforce needs, and that universities are funded to deliver education where it is most needed rather than where it is most cost-effective. Representatives of AHPA elaborated on this matter at one of the committee's public hearings, stating that:
If you are trained in your own state, you are more likely to stay there. If you have to go to Victoria or New South Wales to do your training, chances are you won't go back….and that has been an issue with allied health. It's not so much training as an [occupational therapist] or training as a speech pathologist. It's: where do you go once you are trained and will you go to those areas of shortage.
6.38
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) observed that there are opportunities to establish incentive programs in rural and remote areas for local institutions to deliver courses in disability services, noting that this may help build an appropriately trained local workforce and create much-needed employment opportunities.
6.39
SARRAH asserted that improving education in regional, rural and remote areas requires strong partnerships between the NDIS and the education sector. For example, key stakeholders could be engaged to explore options for:
securing more paid opportunities in the NDIS for rural and allied health university students and graduates; and
strengthening NDIS service linkages with University Departments of Rural Health (UDRHs), which are funded through the Commonwealth-funded Rural Health Multidisciplinary Training (RHMT) program.
The transition from education to employment
6.40
As well as raising concerns about the quality of the training and education for the disability workforce, submitters and witnesses emphasised that efforts should be made to enhance the pipeline of qualified new entrants to the sector, and to better support new graduates and early career practitioners.
Student placements
6.41
Several submitters and witnesses called for an increase in student placements within the disability sector, noting that placements are a proven means of increasing workforce supply and equipping the workforce with the skills, qualifications and expertise to effectively support people with disability.
6.42
Speech Pathology Australia (SPA) stated that the lack of clinical placements in disability has been 'counterproductive' in terms of developing the workforce to support emerging markets. It noted that placements are the responsibility of individual universities, which has resulted in a number of universities having to 'reinvent the wheel' as there is no overarching monitoring process. SPA asserted that a national approach would help correct 'wasteful duplication'.
6.43
The committee also heard that pricing does not support student placements—particularly in regional, rural and remote areas where student placements may be an effective means of addressing challenges associated with thin markets. For example, Ms Claire Hewat, CEO, AHPA, stated that:
Under the NDIS funding but also under Medicare funding, in [Department of Veterans Affairs] funding and even under private health insurance funding, there is no allowance for taking students. The expectation is that somebody will train them somewhere else. Not only is there no allowance for taking them but the students are actually, under those funding schemes, not allowed to touch a patient. They can sit with their hands behind their backs and watch, but they're not allowed to touch a patient.
So you've got this complete disconnect between the training which is provided in the public hospital system, which is supported and funded, and training in primary care and disability, where we just hope that somebody might be nice enough to take students. That clearly is not going to support the workforce pipeline.
6.44
The committee also heard that there is a need for caution in ensuring students on placement are trained before delivering services to people with disability. For example, Mr Ross Joyce, CEO, AFDO, stated that:
I don't believe we would agree that in-training placement would be suitable if somebody hadn't had appropriate training such as certain levels for daily support needs et cetera. Also, as mentioned earlier, that training of disability awareness needs to be a key part of any training that people are going to have. We would see those sort of things as just a workplace induction process as not the way to go.
Supporting early career practitioners
6.45
Evidence indicated that greater support is needed for new graduates and early career practitioners—particularly within allied health. Submitters noted that supervision and mentoring is crucial to attracting and retaining an allied health workforce and ensuring allied health professionals are equipped with the clinical skills to support people with disability in a complex environment such as the NDIS.
6.46
However, submitters expressed concern that professional support is not viable under current pricing arrangements, calling for adjustments to current pricing to support supervision and case discussion. Some submitters also called for incentives for providers who employ early career practitioners, and incentives to encourage experienced practitioners to supervise and mentor.
6.47
Further, support and mentoring is often difficult in regional, rural and remote areas due to the maldistribution of services and the increasing shortage of experienced practitioners—who are increasingly leaving the NDIS due to financial hardship.
Traineeships
6.48
Some submitters and witnesses highlighted traineeships as a possible means of growing the NDIS workforce while also ensuring that workers are equipped to deliver quality disability supports. The Disability Council NSW observed that a solution to the issue of attracting the workforce could be the re-introduction of traineeships on a 'mass scale'.
6.49
However, the committee also heard that are issues around traineeships which may limit their value as a solution to workforce concerns. For example,
Ms Casey Gray, a member of the Disability Council NSW, observed:
If [traineeships] were completed in a bulk style, with low levels of supervision, there would be the risk that they would just be signed off without much attention being given to the detail. For instance, I have knowledge of a person who completed a diploma in counselling and they had their hours in disability signed off by a supervisor who wasn't paying attention to what they were signing off on.
6.50
Evidence also indicated that traineeships may not be workable under current price settings, given the need for a minimum number of supervised hours for each trainee.
National registration and accreditation
Lack of accredited skills and training
6.51
A number of submitters and witnesses expressed concern as to the lack of consistent, nationally recognised skills, training and qualifications standards for disability support workers in the NDIS, and within the broader disability sector. The committee heard that this can lead to considerable variation in the quality of supports that are provided to NDIS participants, and to substantial cost increases for providers.
6.52
Carers NSW raised concern that, in the absence of qualification requirements, workers with limited experience in disability may offer services at low prices. While this may seem appealing to some participants and families, engaging workers without suitable qualifications may place people with disability—and the workers themselves—at risk of significant harm. These concerns were echoed by the Australian Services Union (ASU), which noted that the absence of national standards sends a signal to prospective employees that work in the sector is undemanding (even though this is far from the truth).
6.53
The 'devaluation' of the sector was reflected in a recent report on precarious work in the NDIS. Support workers interviewed as part of the report stated that young, inexperienced workers are increasingly attracted to the sector due to the low entry requirements. Due to the increasing demand for workers and high staff turnover, providers may be obliged to take on workers with neither the skills to support people with disability, nor an interest in the work:
At the moment, our HR manager, she advertises for Cert III but everyone I've spoken to, none of them have got Cert III…[O]ne was working at KFC last Friday night and yet he's out with complex kind of behaviours.
6.54
Mr Tim Wilson, Executive Manager, Workforce Development, Cara, observed that a lack of nationally accredited training means that skills and qualifications are not portable. Mr Wilson noted that Cara is often obliged to retrain its staff to ensure that quality standards are maintained:
If [a support worker] come[s] to us from someone we don't know then we basically have to say, 'We don't recognise that or know what you've done, so we're going to have to put you back through again,' and so that then means we have basically double-trained them. Maybe they then leave us shortly afterwards and go somewhere else and they go through it again. So they're in this constant training ground, and we're constantly, as an industry, just churning through the same training dollars and not really getting anywhere.
6.55
A number of submitters and witnesses called for the development of national standards for skills and qualifications to 'professionalise' the sector. Submitters and witnesses asserted that standards should be predicated on a participant needs analysis, must recognise the skills needed to support specific cohorts, and should be developed by appropriate industry associations with input from support workers, people with disability and representative organisations. For example, People with Disability Australia (PwDA) stated that:
[W]e believe that specified qualifications and continuing professional development training should be mandatory to ensure the rights of people with disability are upheld. The Government must work with disabled people's organisations when determining appropriate qualifications and developing training modules. It is fundamental that the qualifications and training are underpinned by and promote the Convention on the Rights of Persons with Disabilities (CPRD) and the social model of disability.
6.56
Professor Christine Bigby emphasised that the skills and knowledge required by workers will depend on the level and type of disability of the people they are supporting. In this respect, Professor Bigby asserted that one set of uniform standards for the sector would not be appropriate; rather, there should be a series of standards that are group-, impairment- and context-specific.
6.57
Some submitters observed that calls for nationally accredited training are not new. For example, the Vic OPA noted that the Senate Standing Committee on Community Affairs recommended the establishment of a scheme to ensure nationally consistent training in 2015, expressing disappointment that such a scheme has not yet been implemented.
Implementing a professional registration scheme
6.58
Several submitters and witnesses expressed support for a scheme for the registration and professional regulation of support workers, as a means of ensuring consistency in skills and training, facilitating ongoing professional development, and mitigating risks of harm to people with disability.
6.59
National registration might take the form of 'positive' worker screening, with a focus on the skills and competencies needed to deliver safe, quality supports—rather than on the conduct that may exclude a person from working in the sector. Mr Lloyd Williams, National Secretary, HSU, expressed support for a scheme of this type, noting that under such a scheme:
[A] worker…can identify their additional qualifications and skills within their registration, and you pick up screening in that as well. It would also add value to the service providers in terms of identifying the skills that a worker brings.
6.60
Professor Christine Bigby asserted that, as a starting point, the Government should conduct a scoping study of the different types of work under the NDIS, and propose a segmentation of the workforce based on best available evidence from experienced researchers in the field. Working groups could then identify the skills and experience needed to undertake work at 'beginner, competent and advanced' levels. Following this, existing curricula could be examined to determine whether they require updating, or new curricula developed.
6.61
People with Disability Australia (PwDA) noted that a professional registration body such as National Disability Practitioners (NDP) should provide a code of ethics and a set of standards for disability support workers, stating that:
[The] body…can set the standard for course accreditation and set up a continuous professional development scheme so that people with disability can decide whether or not they want to have a support worker who is a professional—someone who's knowledgeable and skilled in contemporary social practices such as rights-based, person-centred practices.
6.62
The Disability Council NSW similarly supported registration through NDP. It also noted that a professional registration scheme might help to address some of the concerns associated with employment via online platforms, stating that:
Employment options such as the relatively new platforms Hire-up or Mable; or disability support workers who have obtained an ABN and now practice independently of organisations altogether should be required to take responsibility for their own continued professional development…in lieu of the training and supervision once provided by organisations.
Along with compulsory worker screenings, there should be a commitment to [continuing professional development]…to stay up to date with the latest in policy and practice to minimise incidents of poor practice such as the potential for abuse and neglect by modern standards.
6.63
As regards a model for the regulation of support workers, the United Workers Union (UWU) pointed to the Disability Worker Regulation Scheme (DWRS) in Victoria, asserting that there should be extensive consultation with workers, providers, people with disability and other key stakeholders to develop a national scheme based on this model. It also observed that there should be a period of transition before a scheme is implemented, so as not to create any unreasonable barriers to working in the sector or disadvantage the existing workforce.
6.64
The committee also heard that mandatory qualifications for the disability workforce should be set at a higher level than is currently accepted within the sector. For example, the Vic OPA noted that it had previously recommended that the NDIA require behaviour support practitioners to have a competency standard equivalent to a Certificate IV in disability.
NDIS Workforce Capability Framework
6.65
In its submission to the inquiry, the Department of Social Services (DSS) observed that the government is developing an NDIS Capability Framework. The framework is intended to translate NDIS Principles, Codes of Conduct and Practice Standards into capabilities to ensure the workforce is able to meet participant needs.
6.66
The NDIS Quality and Safeguards Commission is leading development of the framework. According to the Commission's website, the framework includes 'core capabilities' for providers and workers; 'complementary capabilities' required to assist with tasks that require specific knowledge or expertise; and 'technical capabilities' for workers delivering higher-intensity services. Bendelta, an organisation specialising in workforce capability development, will develop the framework from November 2019. Work is expected to take around 12 months.
6.67
Several submitters expressed their support for the implementation of a capability framework, and made suggestions as to how the framework should operate. Submitters also asserted that the framework should be co-designed with support workers, people with disability, and their representatives.
6.68
For example, PaW stated that a capability framework (as distinct from practice standards) should 'zoom in' on the skills, capabilities and personal attributes required to perform effectively in the disability sector. An example of such a competency would be 'actively listens to colleagues and clients and passes on relevant information accurately and appropriately'. Indigenous Allied Health Australia (IAHA) stated that the framework should include requirements for culturally safe and responsive care.
Harmonising skills and training across sectors
6.69
Some submitters observed that there may be value in harmonising skills and training across adjacent sectors such as disability, health and aged care, noting that this would increase workforce mobility; facilitate career development; reduce duplication of training costs; and provide access to a larger pool of qualified disability workers.
6.70
National Disability Services (NDS) noted that there is a 'convergence' of aged care policies with those underpinning the NDIS, which will continue to drive a move to consolidating some of the skills, qualifications and attributes the two sectors are looking for within their workforce. It stated that identifying and training for competencies that enable a worker to easily move between sectors should be a priority. The Disability Council NSW similarly noted that aged care training is needed for NDIS staff—increasingly so as the population of people with disability ages.
6.71
QAI observed that while many people with disability have interactions with the health and aged care sectors, there is a 'disconnect' between a person's health needs, age-related needs and disability support needs, and limited understanding of disability within the health and aged care sectors. QAI stated that there should be greater focus on cross-training the workforce, noting that this would provide workers with skills that could be shared across sectors while equipping workers to respond to an ageing population.
The value of micro-credentials
6.72
Some submitters and witnesses observed that 'micro-credentials' may be an effective means to ensure support workers have the skills and expertise to deliver quality supports, particularly if coupled with a professional regulation scheme. Professor Christine Bigby explained that micro-credentials are short, high-quality courses that are, or should be, accredited with an industry body, government or a university. Professor Bigby stated that, in the disability sector:
[M]icro credentials in human rights values, supported decision making, active support, basic first aid, swallowing and mealtime support, and administration of medication might be stacked together to demonstrate the competency for direct support work in working with people with intellectual disability and complex medical needs.
6.73
Mr Tim Wilson, Executive Manager, Workforce Development, Cara, observed that micro credentials may be a suitable means of ensuring that the workforce possesses the skills to effectively support people with disability, stating that:
[W]e need to think more laterally about how someone can, through maybe micro-credentialing…tick the boxes to say that, yes, this person does have the skills…How they've achieved them could be largely irrelevant.
6.74
Ms Mary Sayers, CEO, CYDA, similarly observed that micro credentials may be an effective means of ensuring the workforce possesses the necessary skills to deliver quality supports and quickly address identified skills gaps.
Ms Sayers stated that there would be value in 'building in micro-credentials around particular specialties like…ethics, rights, a social model of disability, and the particular needs of children and young people with disabilities'.
6.75
Professor Bigby also noted the value of micro-credentials as an effective means of addressing skills gaps, highlighting their value in 'upskilling' workers for particular programs:
If I am an employer employing people to work in the 15 group homes that I run in my organisation and I also run some community access programs, I would say to people coming to work: 'You need to do a…micro credential in active support. You need to do [one] in supported decision-making. Those of you who are working in community access need to do another one in community inclusion…It enables you to mix and match the skills that the workers you have bring with them or acquire on the job.
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In addition, Professor Bigby observed that micro-credentials could be used to ensure that staff in leadership positions are trained in supervision and practice management, provided that the relevant courses are delivered at a higher (for example, post-graduate) level.
Proposals to address training and development needs
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Some submitters and witnesses proposed specific strategies to address training and development needs within the NDIS workforce.
Portable and training entitlements scheme
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The ASU noted that it commissioned the Australia Institute's Centre for Future Work to develop a portable training entitlements scheme, to provide disability workers with the opportunity to acquire skills and credentials that would improve their jobs, and to enhance service delivery.
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The ASU provided an overview of how the scheme would function:
Induction: This is a minimal induction training package provided to new workers starting with NDIS providers. It would involve 30 hours of on-line and face-to-face orientation to the goals and principles of the NDIS, and core features such as the code of conduct and basic safety practices; and 20 hours of supervised contact with people with disabilities.
…
Foundation: This foundation entry-level course would be required for all new disability support workers within the first 18 months of their employment in NDIS-funded service delivery. It is accredited Cert III specialist NDIS training…[and] would involve 90 hours of classroom training, and 120 hours of workplace training and assessment.
…
Accumulated training entitlement: The largest element of the comprehensive NDIS training program would be the establishment of a portable training entitlement system, through which NDIS…workers would accumulate credits toward additional training. Training credits are earned as workers complete NDIS-funded work—whether with a provider-employer (as permanent or casual workers), or even directly for NDIS participants (working as sole traders).
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According to the ASU, the scheme would be administered by creating a federal authority such as a Disability Services Training Authority, housed within the NDIS Quality and Safeguards Commission.
Disability sector 'white card'
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Mr Tim Wilson, Executive Manager, Workforce Development, Cara, observed that a 'white card' for the disability sector would assist with skills portability:
[I]f we look at what's coming out of the royal commission and we look at the submissions into the Royal Commission for disability and the outcome from the Royal Commission into aged care, I think we can agree that something has got to change in terms of the standards that people apply on a day-to-day basis. I think that a white card would fit neatly in that system. If I look at it as a nationally qualified [registered nurse], I can go to Queensland or WA and I can front up and my qualifications are recognised so away I go. I think that there's something in having that single standard as a level of comfort to providers.
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Similarly, the WA Government noted that it has invested in the development of a 'Skills Passport' as a mechanism for reducing duplication of training costs between providers, increasing the recognition of skills and standardising training requirements. Once the passport is further developed and tested, its scope might be broadened to interface with adjacent sectors.
Committee view
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The committee heard a substantial amount of evidence regarding: skills and qualifications needed for effective disability support; the adequacy of existing training programs; and the need for measures to support transition from education to employment. As discussed in Chapter 9, the committee considers these matters should be captured in the national plan for the NDIS workforce. Preliminary views addressing some identified issues are also set out below.
National registration and accreditation
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The committee heard that there is widespread concern as to a lack of consistent, nationally recognised skills and qualifications within the NDIS—particularly for disability support workers. The committee heard that this may lead to considerable variation in the quality of supports provided to NDIS participants. This is a particular concern for participants with higher or more complex needs, who require support workers with a correspondingly high level of skill and specialised training (for example, in recovery-oriented care, for a worker supporting a participant with psychosocial disability).
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In addition, the committee heard that a lack of nationally accredited training is increasing costs for providers, who are obliged to 'retrain' support workers to meet their own quality standards. Often this training is duplicative—despite being necessary to ensure participants receive safe, quality supports.
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The committee notes that there is widespread support for the development of a national scheme for accreditation, registration and regulation of support workers as a means of 'professionalising' the sector; increasing the portability of skills; and providing assurance to participants that services will be delivered by workers with the necessary skills to ensure quality and safety.
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The committee generally supports implementation of a national accreditation scheme as a means of enhancing the skills and qualifications of the workforce and supporting future workforce growth, and considers that the Government should explore options to develop a national scheme—noting that a scheme of this type already exists in Victoria. Moreover, the committee notes that there are already worker screening processes in place to ensure that disability workers do not pose an unacceptable risk to the safety of participants. As noted by some submitters, there may be merit in leveraging existing screening processes to establish requirements for 'positive' clearance, focussed on the skills, qualifications and competencies of workers.
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The committee remains cognisant that participants will have diverse needs, grounded in factors such as their disability type; personal circumstances; and the availability informal supports. The committee therefore agrees with the view that national benchmarks should be developed for the skills needed to support specific cohorts. These should be developed by appropriate industry associations, and co-designed by people with disability, support workers, their representative organisations, and other relevant stakeholders.
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The committee also understands that there may be a set of core competencies required of all disability support workers, with the additional skills needed to deliver specific services and supports built on this foundation. It is unlikely to be appropriate to require a support worker to undertake a new qualification each time they wish to move to a new service area or each time a participant's needs change. The committee therefore considers that there would be merit in exploring 'micro-credentials' as a means of ensuring the workforce possesses appropriate skills and qualifications—including to 'upskill' the workforce as required.
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The committee appreciates that obtaining relevant qualifications can be costly, and may not be within the economic reach of some existing disability workers and prospective entrants to the NDIS workforce—particularly under current NDIS price settings. According to much of the evidence before the committee, current prices also limit providers' ability to fund professional qualifications or to deliver in-house training.
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The committee is also mindful of ensuring that a national accreditation scheme does not deter workers and service providers from delivering supports under the NDIS, noting that administrative costs—particularly those associated with registration—have led to some providers choosing to de-register or to reduce their service offerings. The committee therefore emphasises that the process to register under any national accreditation scheme must not be unduly costly or burdensome. This is to ensure that the scheme does not act as a barrier to workforce growth, and to maintain choice and control for participants.
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Finally, the committee appreciates that the implementation of national training requirements may create difficulties for some existing support workers, who may not possess the required qualifications. The committee considers that any national accreditation scheme should include transitional arrangements, to ensure the existing workforce is not unduly disadvantaged.
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The committee recommends that the Australian Government review options to develop a national registration and accreditation scheme for disability support workers, as the product of a co-design process with relevant appropriate people. This should include developing national benchmarks for skills, qualifications and competencies which reflect the diversity of people with disability, and which are co-designed by appropriate industry bodies, people with disability and representative organisations, support workers and unions, and other key stakeholders.
Existing education and training programs
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The committee heard from a number of submitters and witnesses about the skills and qualifications needed to deliver quality, safe supports and services. In the view of the committee, there is general consensus that disability support workers require an understanding of disability and its manifestations, grounding in core skills such as communication, rights and ethics, and an appreciation for the social model of disability. Building on this foundation, the workforce must be equipped with additional—often technical—skills to support specific participant cohorts.
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The committee was concerned to hear that existing VET programs may not teach the competencies needed for effective disability support, and that some view the curriculum as being poorly taught and not always reflective of best practice. The committee was also concerned to hear that while university courses in allied health may equip students with clinical competencies, some may lack specific focus on disability practice and may not provide students with grounding in the core skills needed to work effectively with people with disability—such as communication, rights and ethics.
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The committee therefore considers that there would be merit in reviewing and, as appropriate, updating curricula for tertiary courses relating to disability—including certificate-level programs in capabilities related to disability support and degree programs for allied health professions. To ensure that amendments to curricula (if any) are informed by a strong evidence base, the committee considers that an appropriate first step would be a thorough analysis of the skills and training needs of the NDIS workforce, supported by consultation with relevant sectoral stakeholders. The committee notes that this might form part of the development of a national accreditation scheme, discussed above.
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The committee recommends that the Australian Government, through the Tertiary Education Quality and Standards Agency and the National Skills Commission, conduct a thorough analysis of the skills and qualifications required in the disability workforce, informed by extensive consultation with people with disability, support workers, representative organisations and tertiary education providers.
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The committee recommends that—following the needs analysis to which Recommendation 5 refers—the Australian Government facilitate a review of current vocational education and training programs and university courses in disability care and allied health, to ensure that such programs capture the training needs of the National Disability Insurance Scheme workforce and reflect current best practice.